Background:Asian patients have smaller aortic annuli. Although 20-mm balloon-expandable (BE) transcatheter heart valves (THV) are manufactured for transcatheter aortic valve implantation (TAVI) in these cases, the supra-annular design of self-expandable (SE) THV is considered more suitable; however, real-world comparative data are scarce.

Methods and Results:Consecutive TAVI cases (n=330) in a single Japanese center were reviewed. Based on the cutoff for the new-generation 20-/23-mm BE-THV, a small aortic annulus was defined as <330 mm². A considerable number of patients had small annuli: 49/302 (16%). Of these, 33 BE-THV and 13 SE-THV using new-generation valves were compared. Although the SE-THV group had smaller annulus area (median 297 (interquartile range, 280–313) vs. 309 (303–323) mm²(P=0.022)), it had more favorable post-procedural parameters; for SE-THV and BE-THV, respectively, effective orifice area (EOA), 1.5 (1.3–1.6) vs. 1.1 cm²(0.9–1.3) (P=0.002); mean pressure gradient, 7.6 (5.6–11.0) vs. 14.2 mmHg (11.2–18.8) (P=0.001); and peak velocity, 1.8 (1.6–2.4) vs. 2.7 m/s (2.3–3.1) (P=0.001). Although new left bundle branch block was higher with SE-THV (24% and 62%, P=0.02), patient-prosthesis mismatch (PPM) ≥ moderate (indexed EOA <0.85 cm²/m²) was significantly less with SE-THV than with BE-THV (8% vs. 55%; P=0.04). Hemodynamic findings were consistent up to 1 year.

Conclusions:Small annuli are often seen in Asian patients, for whom SE-THV implantation results in favorable hemodynamics with less PPM.

背景：亚洲患者的主动脉瓣环较小。尽管在这些情况下制造了 20 毫米球囊扩张 (BE) 经导管心脏瓣膜 (THV) 以用于经导管主动脉瓣植入 (TAVI)，但自扩张 (SE) THV 的超环形设计被认为更合适；然而，现实世界的比较数据很少。

方法和结果：回顾了一个日本中心的连续 TAVI 病例（n=330）。根据新一代 20-/23-mm BE-THV 的临界值，小主动脉瓣环被定义为 <330 mm ²。相当多的患者有小环：49/302 (16%)。其中，对使用新一代阀门的 33 款 BE-THV 和 13 款 SE-THV 进行了比较。尽管 SE-THV 组的瓣环面积较小（中位数 297（四分位距，280-313）与 309（303-323）mm ²（P=0.022）），但它具有更有利的术后参数；分别对于 SE-THV 和 BE-THV，有效孔口面积 (EOA)，1.5 (1.3–1.6) vs. 1.1 cm ²(0.9–1.3) (P=0.002)；平均压力梯度，7.6 (5.6–11.0) vs. 14.2 mmHg (11.2–18.8) (P=0.001)；和峰值速度，1.8 (1.6–2.4) 与 2.7 m/s (2.3–3.1) (P=0.001)。虽然 SE-THV 的新左束支传导阻滞较高（24% 和 62%，P=0.02），但患者假体不匹配 (PPM) ≥ 中等（指数 EOA <0.85 cm ² /m ²）在 SE- THV 比 BE-THV（8% 对 55%；P=0.04）。血流动力学结果一致长达 1 年。

结论：亚洲患者经常看到小瓣环，对于他们来说，SE-THV 植入导致良好的血流动力学和较低的 PPM。